Purpose

To evaluate high-dose intravenous glucocorticoid treatment on tear inflammatory cytokines and ocular surface parameters in patients with active TED. Correlations between tear inflammatory cytokines and clinical parameters were also investigated.

Methods

This prospective pilot study included 15 moderate-to-severe and active TED patients. Control group consist of 15 sex and age-matched healthy subjects. All TED patients were treated with high-dose intravenous methylprednisolone with cumulative dose of 4.5 g during the therapy subdivided into 12 weekly infusions. Tear concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17A, tumor necrosis factor (TNF)-α, and vascular endothelial growth factor (VEGF) were measured by multiplex bead analysis in TED patients at baseline and 12 weeks after treatment. Ocular surface disease index (OSDI), tear break-up time (TBUT), corneal fluorescent staining, and Schirmer’s test were obtained from TED and controls.

Results

All baseline cytokine levels except for IL-17A were significantly elevated in active TED patients compared with controls. Concentrations of IL-1β, IL-6, IL-8, TNF-α, and VEGF were significantly decreased at 12 weeks compared with baseline. OSDI and TBUT showed significant improvement at 6 and 12 weeks. There were significant positive correlations between IL-6, IL-8, and CAS, and negative correlation was found between IL-6 level and TED duration before methylprednisolone treatment. The reduction of IL-6, IL-8, and VEGF were positive correlated with the reduction in CAS at 12 weeks.

Conclusions

High-dose glucocorticoids treatment improved ocular surface symptom, increased the tear film stability, and decreased tear inflammatory cytokines in active TED. The reduction of the inflammatory cytokines is consistent with the improvement of clinical parameters.

中文翻译：

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用大剂量静脉内糖皮质激素治疗的活动性甲状腺眼疾病患者的泪液炎性细胞因子和眼表变化。

目的

评估大剂量静脉使用糖皮质激素治疗活动性TED患者的泪液炎性细胞因子和眼表参数。还研究了泪液炎性细胞因子与临床参数之间的关系。

方法

这项前瞻性先导研究包括15名中度至重度和活跃TED患者。对照组由15名性别和年龄相匹配的健康受试者组成。所有TED患者在治疗期间均以大剂量静脉注射甲基泼尼松龙治疗，累积剂量为4.5 g，分为12周输注。通过多重磁珠分析法测量白介素（IL）-1β，IL-6，IL-8，IL-10，IL-17A，肿瘤坏死因子（TNF）-α和血管内皮生长因子（VEGF）的泪液浓度。 TED患者在基线和治疗后12周。眼表疾病指数（OSDI），泪液破裂时间（TBUT），角膜荧光染色和Schirmer检验是从TED和对照组获得的。

结果

与对照组相比，活跃的TED患者中除IL-17A外的所有基线细胞因子水平均显着升高。与基线相比，第12周时IL-1β，IL-6，IL-8，TNF-α和VEGF的浓度显着降低。OSDI和TBUT在第6周和第12周显示出显着改善。IL-6，IL-8和CAS之间呈显着正相关，而甲基强的松龙治疗前IL-6水平与TED持续时间呈负相关。IL-6，IL-8和VEGF的减少与12周时CAS的减少呈正相关。

结论

大剂量糖皮质激素治疗改善了活动性TED中的眼表症状，增加了泪膜稳定性并减少了泪液炎性细胞因子。炎性细胞因子的减少与临床参数的改善是一致的。